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Staging for gestational trophoblastic tumors

Reviewers: Mandolin Ziadie, M.D. (see Reviewers page)
Revised: 8 December 2011, last major update December 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

AJCC / UICC TNM classification

Primary tumor (T):
TX: primary tumor cannot be assessed
T0: no evidence of primary tumor
T1 (I): tumor confined to uterus
T2 (II): tumor extends to other genital structures (ovary, tube, vagina and broad ligaments) by metastasis or direct extension

Regional lymph nodes:
● No regional nodal designation (N classification) in the staging of gestational trophoblastic tumors
● Nodal involvement is classified as metastatic M1b disease

Distant Metastasis (M):
M0: no distant metastasis
M1: distant metastasis
M1a (III): lung metastasis
M1b (IV): all other distant metastasis (direct invasion or metastasis to non-genital structures)

TNM descriptors for special circumstances:
m suffix: multiple primary tumors in a single site (recorded in parentheses)
y prefix: classification performed during / after initial therapy
r prefix: recurrent tumor after documented disease-free interval
a prefix: stage determined at autopsy
Residual Tumor (R)
     ● Rx: cannot be assessed
     ● R0: no residual tumor
     ● R1: microscopic residual tumor
     ● R2: macroscopic residual tumor

Prognostic index scores

Factors and scoring:
Age: 0 if < 40, 1 if age 40 or more
Antecedent pregnancy: 0 if hydatidiform mole, 1 if abortion and 2 if term pregnancy
Interval months from index pregnancy: 0 if < 4 months, 1 if 4-6 months, 2 if 7-12 months and 4 if > 12 months
Pretreatment hCG: 0 if < 1000, 1 if 1000-9999, 2 if 10K-99,999, 4 if 100K or more
Largest tumor size, including uterus: 0 if < 3 cm, 1 if 3-5 cm and 2 if > 5 cm
Site of metastases: 0 if lung, 1 if spleen or kidney, 2 if GI tract and 4 if brain or liver
Number of metastases identified: 1 if 1-4, 2 if 5-8 and 4 if > 8
Previous failed chemotherapy: 2 if single drug, 4 if 2+ drugs

Low risk: score of 6 or less (usually treat with single-agent chemotherapy)
High risk: score of 7 or more (usually treat with combined, multiple-agent chemotherapy)

2006 FIGO staging

Stage I tumor confined to the uterus:
IA stage I with low-risk prognostic score
IB stage I with high-risk prognostic score

Stage II tumor extends outside of the uterus, limited to the genital structures:
IIA stage II with low-risk prognostic score
IIB stage II with high-risk prognostic score

Stage III tumor extends to the lungs, with or without known genital tract involvement:
IIIA stage III with low-risk prognostic score
IIIB stage III with high-risk prognostic score

Stage IV tumor involves all other metastatic sites:
IVA stage IV with low-risk prognostic score
IVB stage IV with high-risk prognostic score

2006 FIGO stage groupings (TNM classification and risk category)

Stage I: T1 M0 unknown risk factors:
Stage IA: T1 M0 low risk
Stage IB: T1 M0 high risk

Stage II: T2 M0 unknown risk:
Stage IIA: T2 M0 low risk
Stage IIB: T2 M0 high risk

Stage III: any T M1a unknown risk:
Stage IIIA: any T M1a low risk
Stage IIIB: any T M1a high risk

Stage IV: any T M1b unknown risk:
Stage IVA: any T M1b low risk
Stage IVB: any T M1b high risk

Additional references

CAP Tumor Protocol (PDF FILE)

End of Placenta > Miscellaneous > Staging for gestational trophoblastic tumors

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